Wk of 12.19.16

This is a very sad, but eye opening article giving insight into the ongoing opiate epidemic emerging in the United States. According to the CDC, since 2000, the rate of deaths from drug overdoses has increased by 137%. Despite this fact, I feel as though little has been done to decrease the prescribing, manufacturing and distribution of these pain medications. An interesting quote from the article..., "Was it the dealers who were bringing heroin and pain pills to South Charleston? Or the rural doctors who had first prescribed those pain pills at record rates? Or the small-town pharmacies that had profited off extra-strength oxycodone and fentanyl lollipops? Or the drug companies..." and so on. This brings up an interesting question. Who is to blame for the abrupt increase in opiate related deaths in the US? If there are so many areas that can be regulated, how can we decide which regulation will provide the most benefit.

This article is very sad and heartbreaking. There is no denying that we have a huge problem in our country with opiate addiction. I think it is natural to want to place the blame on one group of people and assume that if we deal with them the problem will be over. However, the truth of the matter is that the epidemic of addiction to opiates didn't begin over night and therefore the problem will not be solved over night. It is a multifaceted issue and solution is as well. One thing we need to do is focus on prevention. Doctors need to be very conservative with their prescribing of opiates and parents/schools need to start an open and honest dialogue with children at a young age about drugs of all kinds and this discussion needs to be continued throughout middle school, high school, college and so on. Once one becomes addicted to opiates it is very difficult to become and remain sober, but if we can prevent the next generation from becoming addicted at such a high rate then we have overcome half the battle in my opinion.

Drug addiction including opioid addiction appears to be getting worse as the years go by (CDC, 2016). Drug overdose has become the leading cause of accidental death in the USA with 55,403 lethal dose related deaths in 2015 alone, with 20,101 caused by opioids (ASAM, 2016). It is terrifying to see children losing their parents at such a young age to something that is preventable. I remember this video I came across back in November www.washingtonpost.com/news/true-crime/wp/2016/11/30/mother-captured-in-heartbreaking-overdose-video-charged-with-child-endangerment/?utm_term=.093e7ec6024c.
As the article states, it is hard to figure out who is responsible for this opioid addiction epidemic. Is it the individuals themselves, pharmaceutical companies, doctors, socioeconomic status or something else? I think all of these factors have contributed to the problem. The article points out how children may become aware of their parents' problems even at an early age. Since many families have just parents and children living in a household, it is important for children to know when their parents need help just like parents may notice a child in trouble. Maybe school curricula can provide education for children to detect signs of drug abuse before it's too late.

I appreciated that the author recognized the need to put human faces to the epidemic, and did so by highlighting the experiences of the children affected. It is devastating to realize that a child, recognizing the reality and prejudices of society that exist against those who struggle with addiction, would have to go to the measures Zaine did when he found his parents dead. Just to highlight Zaine's experience from the article, "He already knew they were dead, and he already knew what some people in South Charleston would say. Just addicts. Just a couple more overdoses. Nobody’s fault but their own. So, while he waited for the medics, he had cleaned the drug residue off the bedroom counter and hid his parents’ used needles in his shoe, hoping the police might mistake it for carbon-monoxide poisoning." I once watched a PBS Frontline documentary on the opioid problem in the US, which also highlighted society's attitudes towards addicts and some of their stories and it changed my perspective on the matter, which has further been changed being here in the clinic and working with some of those suffering from opioid dependence. I remember the first patient I visited with who told me they regretted ever taking the prescribed pain meds because it led them down the road of addiction. They were piecing their life back together little by little with suboxone, but still lived daily with the aftermath of their disease. I definitely feel fortunate to have had these experiences that will guide me, my perceptions of addicts and actions in prescribing, as I go forward to care for patients in the coming years.

As sad as this story is, the worst part is what are health officials and providers doing to stop this? The problem we have today is the huge emphasis on patient satisfaction. I have worked in several hospitals and unfortunately this country hasn't found that balance, why you have patients coming in with google print outs and "medical information" they printed off the internet. There isn't much education that doctors are doing these days, and institutions are so worried about the patient satisfaction surveys, the issue of pain is real and I am sure there are people who truly need pain medications. I do see that physicians don't educate the patients and aren't firm with their decisions on prolonged treatment of controlled substances that can be addictive. Its a sad story, but at the same time, what are health providers doing about it?

I'm really glad to see that this opiate problem is finally coming into light and being taken seriously. It's just horrible that it's taken so long and had to reach epidemic levels to do so. One of my closest friends from undergrad has struggled with heroin addiction for the last 5 years on and off, and I've been witness to some of the hardships this disease has placed on him, his friends, and his family. It's truly tragic. And what's worse is the lack of treatment resources these patients suffering from addiction have. These people are sick and society demands for them to get well, but has not given them the means do to so, because addiction has long been viewed as self inflicted, a decision to be a junkie, not as an illness. As Zaine stated in the article, “As soon as you’re on drugs, it’s like everything is your fault." “People think you’re trash.” “You’re a damn druggie. You’re nothing.” And I think it's for this same reason that we've allowed things to get so bad and the death toll to rise so much. A middle age white male found dead in his suburban home, is a shocking news story until it's found due to a heroin overdose. Then nobody seems concerned, as if that's simply what happens when you do drugs. "Just addicts. Just a couple more overdoses. Nobody’s fault but their own."

We've begun taking small steps to deal with this still growing problem of opiate and opioid addiction, thankfully. The media has started to shed more light on the issue, even John Oliver covered opioid addiction on his HBO show Last Week Tonight. It's a great clip if anyone cares to see I've included the video link. Government has also begun to respond, as many firefighters (as seen in the clip) and even law enforcement officials have begun carrying naloxone. My sister is a cop and her department made them all start carrying naloxone over the summer. And just this month Georgia passed a standing order to make naloxone available over the counter at pharmacies statewide. However, I feel that the greatest responsibility in dealing with this issue lies with us as health care providers. We need to educate ourselves on addiction medicine, which is not a topic covered or studied in our curriculum at any point really, despite being something our country desperately needs more of. We need to educate our patients, and our peers. And we need to practice good medicine, prescribing opiates appropriately and cautiously, carefully monitoring patients to recognize signs of abuse, and offering appropriate treatment and therapy for addiction.

www.youtube.com/watch?v=5pdPrQFjo2o

This article is very saddening. It is very important for people to take use of opioids seriously. There has been an increase in the opioid involving drug overdose deaths in the United States since the 90's. Most of us know that the oerdoses are from prescription opioids leading to overdose deaths. I was reading this fact in an article one day that the prescription opioids have quadrupled since the last 15 years, but the amount of pain that Americans reported has not changed. 
Sadly, heroin use has increased in the young population and most of the users reported abusing other prescription opiates before the start of heroin use. Heroin related deaths have also increased significantly and it is so sad to see that there is so much awareness, but there is still increase in heroin related deaths. I hope we find alternatives to control this drug abuse problem and stop giving opioids to people like they are just candy. But, it is unfair to blame the physicians because pain cannot be measured or tested. It can only be felt by the patients and it is based on the trust by the doctor in the patient to be honest. i hope people understand the seriousness in the usage of the medications one day and we can all respect the people with real pain versus drug abusers.


Thank you.